Cardiac biomarkers some up frequently, but to be honest these questions have generally been referring only to troponin. Observe:
Only Question 27 from the second paper of 2010 takes a broad overview of the cardiac biomarkers. The college answer to that question is a table of advantages and disadvantages, comparing oldies like CRP and ESR with CK, troponin with some exciting novel biomarkers. Since this 2010 paper, none of these exciting novel biomarkers have become commonplace.
Anyway. The college answer to Question 27 consists of a table, listing the advantages and disadvantages of cardiac biomarkers. My response to such things has traditionally been to offer a similar table, but with more detail. This is not necessarily better. To inundate the CICM trainee with excessive tabulated data is sadistic overkill, equivalent to the difference between the fifty-first and the fifty-second stab wound (i.e. is that really necessary?). However, one can conceive of circumstances when such a table might be helpful. And, in contrast to the college model answer, references are offered.
Without further ado, the table is offered below. The treatment of this list is similar to the treatment of the biomarkers of sepsis in their on respective chapter. The cardiac biomarkers are listed in order of apprearance, i.e. the biomarkers which entered routine use in the 1950s are listed first, and all the novel exotic markers are listed last. The chronology of cardiac biomarker development was sourced from the excellent 2014 article by Kent Lewandrowski for Clinics in Laboratory Medicine. For the older biomarker enzymes such as AST, CK and LDH, the best reference is the review article by Sobel and Shell (1972). For more modern techniques, the single best resource for this would have to be the paper by Anthony McLean et al (2012). Unless otherwise stated, this is the main source for the information offered below. If for some reason a berserk excess of tabulated biomarker information is called for, one may want to spend some time with this 2006 article in Circulation.
ESR |
Physiology
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Advantages:
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Disadvantages:
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CRP |
Physiology
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Advantages:
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Disadvantages:
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Physiology
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Advantages:
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Disadvantages:
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Physiology
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Advantages:
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Disadvantages:
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Physiology
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Advantages:
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Disadvantages:
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Physiology:
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Advantages:
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Disadvantages:
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Physiology:
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Advantages:
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Disadvantages:
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Troponin-T and Troponin-I |
Physiology:
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Advantages:
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Disadvantages:
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Physiology:
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Advantages:
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Disadvantages:
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H-FABP |
Physiology:
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Advantages:
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Disadvantages:
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Physiology:
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Advantages:
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This article has a nice graph of cardiac biomarker concentrations over time after an infarct:
Wu et al; National Academy of Clinical Biochemistry Standards of Laboratory Practice: Recommendations for the Use of Cardiac Markers in Coronary Artery Diseases. Clinical Chemistry 45:7 1104 –1121 (1999)
McLean, Anthony S., and Stephen J. Huang. "Cardiac biomarkers in the intensive care unit." Ann Intensive Care 2.8 (2012): 1-11.
Lewandrowski, Kent B. "Cardiac markers of myocardial necrosis: a history and discussion of milestones and emerging new trends." Clinics in laboratory medicine 34.1 (2014): 31-41.
The ECS and AHA statement referred to in the college answer is this article published in Circulation in 2007:
(Kristian Thygesen et al; Universal Definition of Myocardial Infarction. Circulation 2007, 116:2634-2653
This article from Current Opinion in Critical care (2004) discusses the various causes of raised troponin among ICU patients:
Ammann et al,Troponin as a risk factor for mortality in critically ill patients without acute coronary syndromes. Journal of the American College of Cardiology Volume 41, Issue 11, 4 June 2003, Pages 2004–2009
The fact that troponin rise among the critically ill population is associated with a poorer prognosis is supported by this study:
Gunnewiek et al. Cardiac troponin elevations among critically ill patients. Current Opinion in Critical Care: October 2004 - Volume 10 - Issue 5 - pp 342-346
Farthing, Don E., Christine A. Farthing, and Lei Xi. "Inosine and hypoxanthine as novel biomarkers for cardiac ischemia: From bench to point-of-care." Experimental Biology and Medicine (2015): 1535370215584931.
Bedell, Susanna E., and Booker T. Bush. "Erythrocyte sedimentation rate. From folklore to facts." The American journal of medicine 78.6 (1985): 1001-1009.
LaDue, John S. "Laboratory aids in diagnosis of myocardial infarction: Changes in muscle enzymes, erythrocyte sedimentation rate, and C-reactive protein in myocardial infarction." Journal of the American Medical Association 165.14 (1957): 1776-1781.
Riseman, Joseph EF, and Morton G. Brown. "THE SEDIMENTATION RATE IN ANGINA PECTORIS AND CORONARY THROMBOSIS." The American Journal of the Medical Sciences 194.3 (1937): 392-399.
LEVINGER, ERNEST L., H. Y. M. A. N. Levy, and SAMUEL K. ELSTER. "Study of C-reactive protein in the sera of patients with acute myocardial infarction." Annals of internal medicine 46.1 (1957): 68-78.
Ridker, Paul M., Robert J. Glynn, and Charles H. Hennekens. "C-reactive protein adds to the predictive value of total and HDL cholesterol in determining risk of first myocardial infarction." Circulation 97.20 (1998): 2007-2011.
De Beer, F. C., et al. "Measurement of serum C-reactive protein concentration in myocardial ischaemia and infarction." British heart journal 47.3 (1982): 239-243.
Dewar, H. A., N. R. Rowell, and A. J. Smith. "Serum glutamic oxalacetic transaminase in acute myocardial infarction." British medical journal 2.5105 (1958): 1121.
Vincent, William R., and Elliot Rapaport. "Serum creatine phosphokinase in the diagnosis of acute myocardial infarction." The American journal of cardiology 15.1 (1965): 17-26.
Smith, Alistair F. "Diagnostic value of serum-creatine-kinase in a coronary-care unit." The Lancet 290.7508 (1967): 178-182.
Roberts, Robert, et al. "Specificity of elevated serum MB creatine phosphokinase activity in the diagnosis of acute myocardial infarction." The American journal of cardiology 36.4 (1975): 433-437.
Wallimann, Theo, and Wolfram Hemmer. "Creatine kinase in non-muscle tissues and cells." Cellular Bioenergetics: Role of Coupled Creatine Kinases. Springer US, 1994. 193-220.
Sobel, Burton E., and William E. Shell. "Serum enzyme determinations in the diagnosis and assessment of myocardial infarction." Circulation 45.2 (1972): 471-482.
Gibler, W. Brian, et al. "Early detection of acute myocardial infarction in patients presenting with chest pain and nondiagnostic ECGs: serial CK-MB sampling in the emergency department." Annals of emergency medicine 19.12 (1990): 1359-1366.
Tsung, S. H. "Several conditions causing elevation of serum CK-MB and CK-BB." American journal of clinical pathology 75.5 (1981): 711-715.
Puleo, Peter R., et al. "Use of a rapid assay of subforms of creatine kinase MB to diagnose or rule out acute myocardial infarction." New England journal of medicine 331.9 (1994): 561-566.
Mair, Johannes, et al. "Equivalent early sensitivities of myoglobin, creatine kinase MB mass, creatine kinase isoform ratios, and cardiac troponins I and T for acute myocardial infarction." Clinical chemistry 41.9 (1995): 1266-1272.
Gibler, W. Brian, et al. "Myoglobin as an early indicator of acute myocardial infarction." Annals of emergency medicine 16.8 (1987): 851-856.
Stone, M. J., et al. "Serum myoglobin level as diagnostic test in patients with acute myocardial infarction." British heart journal 39.4 (1977): 375-380.
Khan, Sohail Q., et al. "C-Terminal provasopressin (copeptin) as a novel and prognostic marker in acute myocardial infarction leicester acute myocardial infarction peptide (LAMP) study." Circulation 115.16 (2007): 2103-2110.
Reinstadler, Sebastian Johannes, et al. "Copeptin Testing in Acute Myocardial Infarction: Ready for Routine Use?." Disease markers (2015).
Reichlin, Tobias, et al. "Incremental value of copeptin for rapid rule out of acute myocardial infarction." Journal of the American College of Cardiology 54.1 (2009): 60-68.
Raskovalova, Tatiana, et al. "Diagnostic accuracy of combined cardiac troponin and copeptin assessment for early rule-out of myocardial infarction: a systematic review and meta-analysis." European Heart Journal: Acute Cardiovascular Care (2013): 2048872613514015.
Okamoto, Fumio, et al. "Human heart-type cytoplasmic fatty acid-binding protein (H-FABP) for the diagnosis of acute myocardial infarction. Clinical evaluation of H-FABP in comparison with myoglobin and creatine kinase isoenzyme MB." Clinical chemistry and laboratory medicine 38.3 (2000): 231-238.
Slot, MHE Bruins, et al. "Diagnostic value of a heart-type fatty acid-binding protein (H-FABP) bedside test in suspected acute coronary syndrome in primary care." International journal of cardiology 168.2 (2013): 1485-1489.
Orihuela, C. J., et al. "The Heart-Type Fatty Acid-Binding Protein (h-Fabp) Is Associated With Higher Icu Mortality In Severe Septic Patients." Am J Respir Crit Care Med 191 (2015): A6257.